Yes, you read me right. Tonight ABC Nightly News reported that Arizona Governor Jan Brewer has proposed leveling a $50 fine on MedicAid participants who (1) Smoke; (2) Are obese; and/or (3) Have a chronic condition and fail to to meet the goals set by their primary care physicians. According to Phoenix ABC News 15
, Governor Brewer proposed this in order to raise funds for the cash-strapped MedicAid program and to encourage people to take responsibility for their own health. The funds raised from these fines would be used to help support the organ transplant program that was pretty much shut down last year and to allow an increase in the number of people eligible for the MedicAid program.
I see a number of problems with this, not the least of which is that Arizona will be punishing people for things they may not have any control over. For instance, in 2007, the doctor I was seeing placed me on Metformin when my A1c rose to 8%. While the drug brought down my fasting numbers, it did nothing for my post-meal numbers, which were just as high as when I was not taking any medications. Was I being non-compliant? I was certainly taking my medications and following the meal plan given to me by the dietitian. My doctor tried to accuse me of being non-compliant with exercise, even though I did not have a car and had to walk every where I went! Should I be fined because the medication didn't work and because the doctor refused to run the tests that would have helped guide his decision making process? If Actos is the drug that works best at keeping your bgs down but it has also caused you to gain a substantial amount of weight, should you be fined for that, though the weight gain is a direct consequence of the medication? Is it fair to fine someone who has been following his or her program religiously, who has had good bgs for (perhaps) years, but whose body has changed and for whom the program no longer works?
IMO, it's a bad plan. It punishes the people who are least able to afford it. As it is being reported, the behaviors that trigger the fines are not well-defined. A doctor who is angry at you and who wants to "teach you a lesson" (like mine did back in 2007) may write "non-compliant" on your records though it is not the truth and cause you to be fined, for instance. Why fine obesity? For the same reason they're fining cigarettes, IMO: The governor has a misguided belief that both are due to "willful bad choices" and you have a choice in whether you're obese or not. It fails to take into account the contribution of genetics, it fails to take into account that there are some who are both fat and fit. It is unfair legislation, though with good intentions -- and we all know which road is paved with good intentions!
If you live in Arizona and you agree with this, I hope you will take a moment to write to your governor to express your thoughts and offer alternatives. I know these are difficult times but there must be a better way!